In an effort to reduce insurance claim rejections and to increase collections, many healthcare providers perform various checks and verifications of patient information during a registration process or prior to providing healthcare services to the patient. For example, a verification that healthcare providers typically implement is an insurance eligibility and benefits verification, where a patient's insurance coverage and benefits are verified by an information source, such as a payer (e.g., insurance companies, federal and state health plans, etc.) or a clearinghouse.
Healthcare industry standards have been implemented for enabling healthcare providers (optionally via an intermediary system) to submit an electronic inquiry to verify a patient's insurance coverage and benefits with a specified payer and to receive an electronic response comprising information about whether the patient is covered by the payer, and if so, details about the patient's insurance coverage. To check the patient's eligibility, a healthcare provider registrar typically inputs basic information about the patient, the patient's insurance policy information (e.g., the insurance company name, the patient's policy number, etc.), and the type of medical service(s) the patient is to receive.
Due to a variety of factors, oftentimes the information entered by the registrar is inaccurate or does not properly or positively identify a payer. For example, a registrar may not include a state associated with a patient's insurance policy or may not select a correct payer from a list of payers. Additionally, various healthcare providers may use different nomenclatures to identify a payer. Accordingly, a payer to which the eligibility transaction request should be routed may not be correctly identified, and the healthcare provider may not receive the eligibility information needed for a patient. For example, the healthcare provider may receive notice that the patient does not have insurance benefits, although the patient is eligible for coverage. Consequently, transaction data may have to be manually re-keyed, and another eligibility transaction request may have to be submitted. As can be appreciated, this can increase network traffic, and can be both time-consuming and inefficient.
It is with respect to these and other considerations that the present invention has been made.